National policies for Food and Nutrition ; Current

nutritional situation of malnutrition ; Integrated approach

to solve the problems of malnutrition in India.

Submitted by Tamilselvan. T

MALNUTRITION

It is a condition results from eating a diet in which nutrients are

either not enough or are too much such that the diet causes health

problems.

Malnutrition is failure to achieve nutrient requirements, which can

impair physical and/or mental health. It may result from consuming

too little food or a imbalance of key nutrients.

The Government of India is making a comprehensive approach towards the

solution of malnutrition problem in country. The policies and programmes are

broadly divided under the following heads :

1. Increasing the production of Food grains

2. Better utilization of food resources by use of food technology

3. Teaching the common man about the better utilization of the existing

foods already available.

4. To protect the vulnerable groups by preventing against certain nutritional

deficiency diseases and supplementary feeding of most vulnerable

segments.

5. Associated health measures which could indirectly improve the nutritional

status of the people.

National policies for Malnutrition The programmes implemented are:

DIRECT NUTRITION PROGRAMMES:

Ministry of Health and Family welfare 1. National Vitamin A prophylaxis programme2. National Nutritional Anemia prophylaxis programme for mother and

children3. National goiter control programme

Ministry of Human Resource Development4. ICDS Scheme5. Special Nutrition programme6. Balwadi feeding programme7. Mid-day meal programme

Ministry of food and civil supplies1. Nutrition education and extension2. Food fortification programme

INDIRECT NUTRITION PROGRAMMES:Ministry of Health and Family welfare 3. Primary health care services.4. Immunization programmes5. Family welfare programmes.

Ministry of food and civil supplies6. Storage of food grains and general warehousing7. Public food distribution systems

Ministry of Agriculture and Rural Development

1. Krishi vigyan kendras.(KVK)

2. National Rural Employment Programme (NREP)

3. Rural Landless Employment Guarantee Programme (RLEGP)

4. Integrated Rural Development Programme (IRDP)

5. Training of Rural Youth for Self-Employment (TRYSEM)

6. National Food for Work programme (NFFWP)

National policies for food and Nutrition :

ICDS scheme

Antodaya Anna Yojana (AAY)

Annapurna Scheme

Balwadi nutrition programme

Special nutrition programme

Mid-day meal programme

TamilNadu Integrated Nutrition Programme (TINP)

Public Distribution system

Wheat based nutrition program

Vitamin A prophylaxis programme

Nutritional Anemia prophylaxis programme for mother and children

National goiter control programme

INTEGRATED CHILD DEVELOPMENT SERVICES:

It remains the worlds most unique early childhood development

programme.

It was launched on 2nd October ,1975 in pursuance of the national policy

for children in 33 experimental blocks.

It is the largest nutrition program implemented by the government of India.

This scheme was funded by Central govt. of India and partly by UNICEF.

This scheme comes under Ministry of social welfare.

The ICDS is implemented through Anganwadi centers. At present 13.42

lakh operational anganwadi’ s in India.

OBJECTIVES:

To improve the nutrition and health status of children aged 0-6 years.

To lay the foundations for proper psychological, physical and social

development of the child.

To reduce the incidence of mortality, morbidity, malnutrition and school

drop-out.

To achieve effective coordinated policy and its implementation amongst

the various departments to promote child development.

To enhance the capability of the mother to look after the normal health

and nutritional needs of the child through proper nutrition and health

education.

Beneficiaries under ICDS :1. Child below 6 years2. Pregnant and lactating mothers3. Women in the age group of 15-44 years residing in socially

backward villages and urban slums.

Beneficiaries getting supplementary foods under ICDS :

Children 6- 35 months 59.3 %

Children 36-71 months 27 %

Pregnant women 47 %

Lactating mothers 72.9 %

Services provided under ICDS scheme:

Supplementary Nutrition

Immunization.

Health check up

Referral services

Treatment of minor illnesses

Nutrition and health education to women

Preschool education to children in the age group of 3-6 years

Convergence of other supportive services like water supply, sanitation

SPECIAL NUTRITION PROGRAMME:

This programme launched in 1970-71 to provide supplementary

feeding for children in 0-3 years age group living in tribal areas and

urban slums.

It later extended to children 3-6 years , Pregnant and nursing mothers.

The daily supplementation consists of 200-300 calories and 10-12g of

protein/ child / day.

Also 500 calories and 25g of protein / month / day.

Supplementary food provided for 300 days in a year.

Folic and Iron tablets are also provided.

The cost of supplementation same as ICDS scheme.

The programme is implemented through a network of Balwadi’s , which

are located at the village/community level.

During fifth five year plan in was included in Minimum Needs

Programme.

This comes under Ministry of social welfare .It is now merged with

ICDS scheme.

BALWADI FEEDING PROGRAMME:

This programme launched by Ministry of social welfare in 1970.

It is mainly for pre-school children implemented through Balwadi's and day

care centers.

The children are given Pre school education and the supplementary nutrition

provided contains 300 calories and 10g of protein for 270 days in a year.

The target group is provided food supplements to 1/3 of total energy

requirement and half of protein requirements.

The programs were launched to enhance the admissions and retain students

in the school to improve literacy and also to improve the health status of

children

Balwadi's are being run by the five national voluntary organization.

MID-DAY MEAL PROGRAMME:

This programme was launched in 1962 by the Ministry of education

and was implemented throughout the country for school children in age

group of 6-11 years of age.

The program was launched to enhance the admissions and retain

students in the school to improve literacy and also improve health status

of children.

The meal should be hygienic that demands monitoring of the raw

material and cooked preparation by trained personnel.

The children in classes 1-8 th could be included as beneficiaries of the

program.

PRINCIPLES:

1. Supplement the children, not substitute to home diet

2. 1/3 of total energy requirement/day and ½ of total protein

requirement/day.

3. Reasonably low cost

4. Easily prepared at schools.

5. As for as locally available food.

6. Change menu frequently.

This program is Centrally sponsored and assisted by CARE ( cooperative

of American relief everywhere).

APPLIED NUTRITION PROGRAMME (ANP) :

It was first implemented in Orissa & Andhra Pradesh in 1962.

By the 1973, the whole country was covered by the scheme.

The program was initiated as a centrally sponsored scheme but now is

being implemented by the states.

This programme till date is the best  conceived nutrition programme but

it could not achieve the desired results due to management failure.

ANP is at present a non-expandable, low priority programme as

compared to other nutrition programmes implemented by the states.

Objectives:

To make people conscious of their nutritional needs.

To increase production of nutritious foods and its consumption

To provide supplementary nutrition to vulnerable groups through local

production of foods.

Beneficiaries :

Children between 3-6 years 

Pregnant and lactating mothers.

Activities:

ANP envisaged production of nutritious food by people themselves and

to be consumed by them to improve their own nutritional status.

Poultry farming, horticulture, beehive keeping, kitchen gardening and

nutrition education were the main activities in the program.

Also, supplementary nutrition was provided to children and women

beneficiaries.

The programme is implemented under the supervision of Block

Development Officer.

WHEAT BASED NUTRITION PROGRAMME:

The WNP is a centrally sponsored scheme started in 1986.

Initially , this scheme was meant to cover additional beneficiaries who

could not be covered by the ICDS projects. However , from 1990, only

the beneficiaries of the central sector ICDS projects are provided

supplementary nutrition under this scheme.

OBJECTIVES:

To enlarge the scope of existing nutrition program by covering

additional beneficiaries, i.e., preschool children and nursing and

expectant mothers through wheat based supplementary nutrition.

Beneficiaries:

Children of preschool age

Nursing and expectant mothers in disadvantaged areas.

Activities:

Under this scheme supplementary nutrition is provided to the preschool

children and pregnant and expectant mothers.

The scheme consists of two components:

The centrally funded component

State funded component.

Centrally funded component:

Under the centrally sponsored WNP ,

supplementary food containing 300 calories and 10 gm of protein is given

to children and 500 calories and 20 gm of protein to expectant and nursing

mothers. Assistance at a cost norm of 75 paise per beneficiary per day for

25 days in a month is provided.

Out of 75 paise, the GOI contributes 50 paise and the balance 25 paise is

borne by the concerned state governments themselves

State funded component:

under this component, wheat was initially

provided to the state governments at a subsidy of Rs. 700 per month to

provide supplementary nutrition to the beneficiaries covered by the state

government nutrition program.

From 1989, no subsidy is given to the state governments. The states

are, however, now provided wheat at the public distribution system

(PDS) rate.

NATIONAL NUTRITIONAL ANEMIA PROPHYLAXIS PROGRAMME

Nutritional anemia is major public health problem in India.

The NNAPP was started in 1970.

It is a centrally sponsored scheme.

Anemia especially affects women in the reproductive age group and

young children.

It is estimated that over 50% of pregnant women suffer from anemia.

Fortification of salt with iron. a universally consumed dietary article.

has been identified as a measure to control anemia.

Under the programme, the expectant and nursing mothers as well as

women acceptors of family planning are given one tablet of iron and folic

acid containing 60 mg elemental iron (180mg of ferrous sulphate and 0.5

mg of folic acid)

Children in the age group 1-5 years are given one tablet of iron

containing 20 mg elemental iron (60 mg of ferrous sulphate and 0.1 mg

folic acid) daily for a period of 100 days.

This programme covered children and pregnant women with

hemoglobin level less than 8 gm per cent and 10gm percent respectively.

Objectives:

Assess the baseline prevalence of nutritional anemia in mothers and

young children through estimation of hemoglobin levels.

To put the mothers and children with low Hb levels (less than 10 and less

than 8 g, respectively) on anti anemia treatment.

To put the mother with Hb level more than 10 g/dl and children with Hb

more than 8 g/dl on the prophylaxis program.

To monitor continuously the quality of the tablets , distribution and

consumption of the supplements.

To assess periodically the Hb of the beneficiaries

To motivate the mother to consume the tablets through relevant nutrition

education (and to give to their children).

NATIONAL VITAMIN A PROPHYLAXIS PROGRAM:

Vitamin –A deficiency is a major public health problem among

preschool children in India.

It was launched in 1970 and presently covers 30 million beneficiaries.

The program comprises a long term and a short term

Strategy.

The Short term intervention focuses on administration of

Mega doses of vitamin-A on periodic basis,

the Long term strategy emphasizes on dietary intervention to

increase the intake of food which are rich in vitamin-A.

Objectives:

The specific objective o the program is to reduce the diseases and

prevent blindness due to vitamin-A deficiency.

Activities:

A massive dose of vitamin-A is given every 6 months to children

between the ages of 6 months to 5 years.

The scheme give priority to children aged between 6 months to 3 years

as a highest prevalence of clinical sign of vitamin-A deficiency are

reported in this age group.

In 1980, the Department of Food introduced a scheme of

Fortification of Milk with Vitamin A to prevent nutritional blindness.

The Recommended schedule for Dose Administration:

6-11 months old - one dose of 1,00,000 IU

1-5 years old - 2,00,000 IU every six months.

A child is expected to receive a total 10 doses of vitamin-A before his

fifth birthday.

The long term strategy emphasize the improvement of dietary intake of

vitamin-A through regular consumption of vitamin-A rich food such as

dark green leafy vegetable, yellow vegetables and fruits, dairy products

and the promotion of breast feeding.

NATIONAL GOITRE CONTROL PROGRAMME:

The National Goiter Control Program was launched by the government

of India in 1962 in the goiter belt in the Himalayan region and iodized

salt was supplied in goiter endemic areas.

Later on in 1986 this program was changed to National Iodine

Deficiency Disorders Control Program (NIDDCP) because the problem

was found to be widespread and more than the problem of goiter.

Objectives:

To conduct the initial surveys to assess the magnitude of the iodine

deficiency disorder.

To supply iodized salt in place of common salt to the entire country.

To conduct resurveys to assess the impact of iodized salt after 5 years.

Beneficiaries:

All people residing in endemic and non-endemic areas for IDD are the

intended beneficiaries. However , the endemic areas are to be given

priority.

Activities:

Iodization of salt: In order to control the problem of IDD, the

government of India has initiated steps since 1st April , 1986 for universal

iodization of edible salt in a phased manner by the year 1992.

Notification for banning use of non-iodized salt: The sale of non-

iodized salt has been banned completely in 18 states and partially in 6

states. The government stands firmly committed to universal iodization

of salt.

Establishment of Goiter cell

Information , education and communication activities.

TAMILNADU INTEGRATED NUTRITION PROJECT(TINP)

This programme was started in 1982.

Aims:

To increase health coverage of all under weight pre-school children and also

improve immunization programme.

To reduce the incidence of PEM among children under 3 years of age.

To reduce the infant mortality rate through immunization

To reduce incidence of Vitamin A deficiency in children under 5 years of age.

Reduction in incidence of Nutritional Anemia in Pregnant and Nursing

women.

Beneficiaries:

1. Children of 6-36 months of age (< Normal wt.)

2. Pregnant and Lactating women belong to poor sections.

Four Components:

A). Nutrition and Growth Monitoring:

TINP center for every 1500 population.

Children below 3 years are weighed every month and children

with PEM are given supplementary feeding.

Supplementary feeding is discontinued when child moves to

higher grade and weight gain of 500 gms over 1 month in 6-12 months

age groups and in 3 months in 13-36 months age group.

Pregnant women covered during last trimester of pregnancy and

Nursing women during the first four months of Nursing based on pre health

and Income criteria.

Supplementary food contains Wheat -35% , Jowar - 20 %, Jaggery- 25%

Edible oil – 10% and Roasted Bengal gram- 10%.

Children < 2 yrs - 40 gms / Day

Children between 2-3 yrs. - 80 gms / Day

Women - 80 gms / Day

Normally a child is covered under the project for 90 days.

2). Health care:

Iron tablets are also distributed to Pregnant and Lactating

women.

Children below 6 yrs of age are given Vitamin A solution.

3). Communication:

The community worker uses Traditional methods like Folk theatre

and arts and Folk songs for educating mothers about Immunization,

Nutrition importance, Methods of combating diarrhoea.

4). Monitoring:

The project staff monitor the impact of the project on the target

population.

ANTYODAYA ANNA YOJANA (AAY)

Launched in 2000 for the poorest of the poor.

This scheme reflects the commitment of govt. of India to ensure food security for all and create a hunger free India.

Target group: Estimated that 5% of the population are unable to get 2 square meals a day.

Identifies 1 crore families(5 crore people) out of the BPL families who would be provided 35 kg per family per month.

Food grains will be issued by the Govt. of India @2 Rs. per kg for wheat and 3 Rs. Per kg of rice.

ANNAPURNA SCHEME:

Aims at providing food security to meet the requirement of senior

citizens not receiving any old age pensions. (NOAPS).

10 kg of food grains/month are to be provided ‘Free of cost’ to the

beneficiaries.

Age of beneficiary should be 65 years or above.

PUBLIC DISTRIBUTION SYSTEM: (PDS)

PDS in India is the largest distribution network of its kind in the world.

With a network of more than 4.62 lakh fair price shops distributing commodities worth more than Rs. 30,000 crore annually about 160 million people.

It supplies food grains namely wheat , Rice besides Sugar, Kerosene and imported Edible oils.

PDS implemented earlier was criticized of failure to serve the population BPL due to its urban bias,

Limited coverage in the states with high concentration of rural poor,

Lack of transparent and accountable arrangements for delivery.

so in 1997, The GOI launched the Targeted Public Distribution

System (TDPS) with focus on the poor.

It gives food subsidy to BPL families, GOI increased the

allocation of food grains from 10 to 20 kg per family per month.

NATIONAL FOOD FOR WORK PROGRAMME: (NFFWP)

Aims at protecting the real wages of workers besides increasing

nutritional standards of families of the Rural poor.

Under the scheme, food grains are given part of wages to the

rural poor at rate of 5 kg per Monday at uniform BPL rate.

It is centrally sponsored scheme and food grains are provided at

free of cost.

NATIONAL RURAL HEALTH MISSION (NRHM)

NRHM is now under National Health mission is an initiative

undertaken by GOI to address the health needs of under- served rural areas.

Launched in April 2005 by PM Manmohan Singh.

Initially tasked for 18 states which are having weak public health indicators.

on May 1, 2013 the GOI launched National Urban Health Mission under

NHM.

The thrust of the mission is on establishing a fully functional, community

owned, decentralized health delivery system with inter-sectoral convergence at

all levels, to ensure simultaneous action on a wide range of determinants of

health such as water, sanitation, education, nutrition, social and gender equality

Rashtriya Bal Swasthya Karyakram (RBSK)

Under NHM, it is an initiative aiming at early identification and

early identification for children from Birth to18 years.

It covers 4 D’s , i.e., Defects at birth, Deficiencies, Diseases and

Developmental delays including disability.

Screening :

1. At delivery points - Medical officers

2. From 48 hrs. – 6 weeks - ASHA at home .

3. 6 weeks to 6 years - Anganwadi centers.

4. 6 years to 18 years - School.

CURRENT NUTRITIONAL SITUATION OF MALNUTRITION

India is one of the fastest growing countries in terms of population and

economics but majority of population at or below the poverty line.

The major cause of Malnutrition in India is Economic Inequality, due to

this peoples diet lack in Quality and Quantity.

India’s Hunger is still worse than African countries.

According to Global Nutrition report 2016 India ranks

in Stunting – 114 out of 132 countries , Wasting – 120 out of 130 countries,

Anemia – 170 out of 185 countries. (ranks from Lowest to Highest).

INTEGRATED APPROACH TO SOLVE THE PROBLEM OF

MALNUTRITION IN INDIA.

DIRECT INTERVENTIONS – SHORT TERM

1.Nutrition intervention for specially vulnerable groups.

a. Expanding the safety net.

Increasing the covering areas of ICDS and other nutrition policies.

b. Growth Monitoring.

c. Reaching the Adolescent girls.

These group are more vulnerable and it is important to creating

awareness through Non-Formal education for particularly Nutrition and Health

Education.

d. Ensuring better coverage of Pregnant and lactating women.Care should be taken to prevent Low birth of

children by educating mothers. Providing health tablets and importance of Breast feeding should be explained.

2. Fortification of Essential foods.Essential food items should be fortified with

appropriate nutrients.ex: Salt with Iodine and/or Iron, Milk with Vitamin A.

3. Popularization of low-cost Nutritious foods: Efforts to produce and popularize low cost

nutritious food from Indigenous and locally available raw materials.

4. Control of Micro- Nutrient Deficiencies among Vulnerable groups.

INDIRECT INTERVENTIONS – LONG TERM:1. Food security :

Per capital availability of food grains need to be attained. The average Indian had access to 2,455 kcal per day with protein - 60 gm and fat – 52.1 gm . Food grains availability is 510.8 gms / day.

2. Improvement of dietary pattern through production and demonstration:

Increasing food production to meet growing needs.

3. Improving the purchasing power:Implementing poverty alleviation programs to

increase purchasing power of the lowest economic segments of population. Ex: IRDP.

4. Public distribution system :Efficient use of PDS to ensure availability of

essential food items in subsidiary price in rural areas.

5. Land reforms:Implementing land reform measures so that the

vulnerability of landless and landed poor could be reduced. Creating awareness for increasing production by modern practices.

6. Health and family welfare.Facilities for increasing Health and

Immunization facilities shall be provided to all. Improved pre- natal and post- natal care to ensure safe motherhood made accessible to all women.

7. Basic Health and Nutrition Knowledge.8. Prevention of food Adulteration.9. Nutrition Surveillance:

Periodical monitoring of Nutritional status of children, Adolescent girls, Pregnant and Lactating mothers and based on data policies have to be made.

10. Research :Research into various aspects of nutrition, both

on the consumption side as well as supply side. Research should enable selection of new

varieties of food with high nutritional value which can be within the purchasing power f poor and also which prevents malnutrition.

11. Communication

12. Minimum wage administration.

13. Education and Literacy.

14. Improvement of status of women.

REFERENCES

1. www. Indianpediatrics.net2. www.ifpri.org3. www. Transformnutrition.org4. www.Wikipedia.org6. www.unicef.org5. India . Ministry of food and civil supplies, Food and Nutrition board.

Integrated Nutrition education- A handbook .1991.6. India . Ministry of Human Resource Development , Department of

Women and child development . National nutrition policy. 1993.7. Public health foundation of India, 2015. India health report – Nutrition.

New Delhi.8. India. Ministry of statistics and Programme implementation.

Children in India – A statistical Appraisal. 2012.9. International Food Policy Research Institute, 2016 , Global Health

Report from promise to impact, Washington

THANK YOU …